Risk Prediction of Femoral Head Necrosis After Internal Fixation of Neck of Femur Fractures
Objective To construct a risk prediction model of femoral head necrosis after internal fixation of neck of femur fracture,and to verify the model.Methods The clinical data of 312 patients with neck of femur fracture treated by internal fixation in Kaifeng Central Hospital from January 2014 to June 2021 were retrospectively analyzed.All patients were randomly divided into the modeling group(208 cases)and the validation group(104 cases)according to a 2∶1 ratio,and the complications of postoperative femoral head necrosis were counted.Multiple logistic regression analysis was used to screen out the risk factors for concurrent femoral head necrosis,and a nomogram risk prediction model was constructed.The model was validated using the receiver operating characteristic(ROC)curve,calibration curve,and decision curve.Results A total of 56 out of 312 patients developed femoral head necrosis after surgery,with a complication rate of 17.95％.There was no statistically difference in clinical data between the modeling group and the validation group(P＞0.05).There were statistically differences in the causes of fractures,Garden classification,fracture line position,fracture to surgery time,preoperative traction,Garden alignment index and removal of internal fixation between the concurrent group and non-concurrent group in the modeling group of patients(P＜0.05).Multivariate logistic regression analysis showed that Garden classification Ⅲ-Ⅳ,time from fracture to operation＞48 hours,preoperative traction,Garden alignment index Ⅲ-Ⅳ and removal of internal fixator were risk factors for femoral head necrosis after internal fixation of neck of femur fracture in the modeling group(P＜0.05).A nomogram risk prediction model was constructed based on risk factors.The ROC curve showed that the predicted areas under the curve for the modeling group and validation group were 0.814(0.745-0.872)and 0.789(0.724-0.850),respectively.The consistency indices of the modeling group and validation group were 0.862 and 0.847,respectively.The calibration curves of both groups were consistent and close to the predicted curves.The decision curve showed that the column chart model has good clinical application effects in both the modeling group and validation group.Conclusion A nomogram model for predicting the risk of femoral head necrosis after internal fixation of femoral neck fractures was constructed based on the causes of fractures,Garden classification,fracture line location,fracture to surgery time,preoperative traction,Garden alignment index and removal of internal fixators.The model has good discrimination,calibration,and clinical application effects.
femoral neck fractureosteonecrosis of the femoral headinternal fixation surgeryrisk prediction model
万方数据
维普
